Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR

Stephen Gerfer; Elmar W. Kuhn; Hannah Gablac; Borko Ivanov; Ilija Djordjevic; Victor Mauri; Matti Adam; Navid Mader; Stephan Baldus; Kaveh Eghbalzadeh; Thorsten C. W. Wahlers

doi:10.1055/s-0042-1750304

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2023; 71(02): 101-106
DOI: 10.1055/s-0042-1750304

Original Cardiovascular

Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR

Authors

Stephen Gerfer ^*

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Elmar W. Kuhn^*

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Hannah Gablac

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Borko Ivanov

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Ilija Djordjevic

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Victor Mauri

²Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
Matti Adam

²Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
Navid Mader

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Stephan Baldus

²Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
Kaveh Eghbalzadeh ^*

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
Thorsten C. W. Wahlers^*

¹Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany

Abstract

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Abstract

Background Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR.

Methods A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes.

Results Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart–lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit.

Conclusion Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.

Keywords

TAVR - cardiopulmonary resuscitation - CPR - low ejection fraction

Full Text

References

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